H5N1

SARS-CoV-2 incidence in K–12 school districts with mask-required versus mask-optional policies — Arkansas, August–October 2021

Just in time for the Great Unmasking of spring 2022. Via MMWR: SARS-CoV-2 Incidence in K–12 School Districts with Mask-Required Versus Mask-Optional Policies — Arkansas, August–October 2021. The summary:

What is already known about this topic?  

Masks are an important part of a multicomponent prevention strategy to limit transmission of SARS-CoV-2. Some school jurisdictions required masks in K–12 schools for fall 2021, while others did not.  

What is added by this report?  

In Arkansas during August–October 2021, districts with universal mask requirements had a 23% lower incidence of COVID-19 among staff members and students compared with districts without mask requirements.  

What are the implications for public health practice?  

Masks remain an important part of a multicomponent approach to prevent COVID-19 in K–12 settings, especially in communities with high levels of COVID-19.

Decline in COVID-19 hospitalization growth rates associated with statewide mask mandates — 10 states, March–October 2020

Via MMWR: Decline in COVID-19 Hospitalization Growth Rates Associated with Statewide Mask Mandates — 10 States, March–October 2020. The summary:

What is already known about this topic? 

Wearing masks is recommended to mitigate the spread of COVID-19. 

What is added by this report? 

During March 22–October 17, 2020, 10 sites participating in the COVID-19–Associated Hospitalization Surveillance Network in states with statewide mask mandates reported a decline in weekly COVID-19–associated hospitalization growth rates by up to 5.5 percentage points for adults aged 18–64 years after mandate implementation, compared with growth rates during the 4 weeks preceding implementation of the mandate. 

What are the implications for public health practice? 

Mask-wearing is a component of a multipronged strategy to decrease exposure to and transmission of SARS-CoV-2 and reduce strain on the health care system, with likely direct effects on COVID-19 morbidity and associated mortality.

US COVID-19 numbers drop, but race against new strains heats up

Via The Associated Press: US virus numbers drop, but race against new strains heats up. Excerpt:

Coronavirus deaths and cases per day in the U.S. dropped markedly over the past couple of weeks but are still running at alarmingly high levels, and the effort to snuff out COVID-19 is becoming an ever more urgent race between the vaccine and the mutating virus.  

The government’s top infectious-disease expert, Dr. Anthony Fauci, said the improvement in numbers around the country appears to reflect a “natural peaking and then plateauing” after a holiday surge, rather than the arrival of the vaccine in mid-December. 

The U.S. is recording just under 3,100 deaths a day on average, down from more than 3,350 less than two weeks ago. New cases are averaging about 170,000 a day after peaking at almost 250,000 on Jan. 11. The number of hospitalized COVID-19 patients has fallen to about 110,000 from a high of 132,000 on Jan. 7. 

States that have been hot spots in recent weeks such as California and Arizona have shown similar improvements during the same period. 

On Monday, California lifted regional stay-at-home orders in favor of county-by-county restrictions and ended a 10 p.m. curfew. The shift will allow restaurants and churches to resume outdoor operations and hair and nail salons to reopen in many places, though local officials could maintain stricter rules. 

Elsewhere, Minnesota school districts have begun bringing elementary students back for in-person learning. Chicago’s school system, the nation’s third-largest district, had hoped to bring teachers back Monday to prepare for students to return next month, but the teachers union has refused. Illinois announced that more counties will be able to offer limited indoor dining.  

“I don’t think the dynamics of what we’re seeing now with the plateauing is significantly influenced yet — it will be soon — but yet by the vaccine. I just think it’s the natural course of plateauing,” Fauci told NBC’s “Today.” 

Ali Mokdad, a professor of health metrics sciences at the University of Washington, said that a predicted holiday surge was reduced by people traveling less than expected, and an increase in mask-wearing in response to spikes in infections has since helped bring the numbers down. 

Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, said too few people have been vaccinated so far for that to have had a significant impact on virus trends. She said she can’t predict how long it will take for the vaccines’ effects to be reflected in the numbers.  

Rivers said she is concerned that the more contagious variants of the virus could lead to a deadly resurgence later this year. 

“I think we were on track to have a good — or a better, at least — spring and summer, and I’m worried that the variants might be throwing us a curveball,” she said.

COVID-19 fight hits defiance, suspicion in rural California

Tehama County. Google Maps

A discouraging report from The Los Angeles Times: COVID-19 fight hits defiance, suspicion in rural California. Excerpt:

RED BLUFF, Calif. —  Jeremiah Fears sat beneath an elk head mounted on the wall of the volunteer fire department in his little city and rolled up his sleeve for what he hopes is a step toward normality: his first dose of Moderna’s COVID-19 vaccine. 

“If we can get vaccinated and do our thing to protect one another and ourselves, we can hurry up and open and go from there,” said Fears, chief of the Corning Police Department. “I know there’s controversy behind it. But it is what it is.”  

Fears had come to a vaccination clinic in Corning — population 7,600 — aimed at firefighters and police officers. But in that fire station was a hint of the pandemic skepticism that runs deep in rural Northern California: two elderly people, both on dialysis, who were coming to get their shots.  

They had been put on standby because Tehama County health officials, who only brought two small vials containing 20 doses, suspected they might not attract enough firefighters or police officers to use them all. 

In the battle against COVID-19, health officials in Northern California face the daunting task of vaccinating more than 683,300 people spread across a mountainous, heavily forested region where calamity — either from illness or physical trauma — can mean hours-long drives to the nearest medical facility. 

Among their biggest obstacles: overcoming widespread skepticism that the virus is a serious threat in far-flung towns, fear that the new vaccine is unsafe, and open rebellion against health orders. The pushback in rural parts of California is emblematic of the challenge in many parts of the United States, particularly outside more liberal urban centers.  

“We’re getting very frustrated here in Northern California,” said Dr. Richard Wickenheiser, the Tehama County health officer. “We have a lot of anti-vaxxers and a lot of independent people who just feel that COVID was a hoax, that it was going to go away when the election was over. And that didn’t happen. ... The excuses just go on and on.” 

Public health messaging, he said, “isn’t working.”

One year, 400,000 coronavirus deaths: How the US guaranteed its own failure

Via The New York Times, what journalists like to call a "damning indictment": One Year, 400,000 Coronavirus Deaths: How the U.S. Guaranteed Its Own Failure. Excerpt, with my bolding:

“We will manage the hell out of this operation,” Mr. Biden said on Friday. “Our administration will lead with science and scientists.” 

The strategy signals a shift from the past year, during which the Trump administration largely delegated responsibility for controlling the virus and reopening the economy to 50 governors, fracturing the nation’s response. Interviews with more than 100 health, political and community leaders around the country and a review of emails and other state government records offer a fuller picture of all that went wrong:  

• The severity of the current outbreak can be traced to the rush to reopen last spring. Many governors moved quickly, sometimes acting over the objections of their advisers. The reopenings nationally led to a surge of new infections that grew over time: Never again would the country’s average drop below 20,000 new cases a day.  

• Science was sidelined at every level of government. More than 100 state and local health officials have been fired or have resigned since the beginning of the pandemic. In Florida, leading scientists offered their expertise to the governor’s office but were marginalized, while Gov. Ron DeSantis turned to Dr. Scott W. Atlas, a Trump adviser, and others whose views were embraced in conservative circles but rejected by scores of scientists. 

• While the president publicly downplayed the need for masks, White House officials were privately recommending that certain states with worsening outbreaks require face coverings in public spaces. But records show that at least 26 states ignored recommendations from the White House on masks and other health issues. In South Dakota, Gov. Kristi Noem, boasted to political allies about not requiring masks even as her state was in the midst of an outbreak that became one of the worst in the nation. 

Gov. Jared Polis of Colorado said states had faced difficult choices in balancing the virus — often hearing competing voices on how to do it best — and said Mr. Trump had left them without the political support they needed as they urged the public to accept masks and social distancing. “The single biggest thing that would have made a difference was the clarity of message from the person at the top,” Mr. Polis said in an interview.  

The pandemic indeed came with significant challenges, including record unemployment and a dynamic disease that continued to circle the globe. Without a national strategy from the White House, it is unlikely that any state could have fully stopped the pandemic’s spread.  

But ​the majority of deaths in the United States have come since the strategies needed to contain it were clear to state leaders, who had a range of options, from mask orders to targeted shutdowns and increased testing. Disparities have emerged between states that took restrictions seriously and those that did not.  

America now makes up 4 percent of the world’s population but accounts for about 20 percent of global deaths. While Australia, Japan and South Korea showed it was possible to keep deaths low, the United States — armed with wealth, scientific prowess and global power — became the world leader: it now has one of the highest concentrations of deaths, with nearly twice as many reported fatalities as any other country.

PAHO Director says new variants and acceleration of COVID-19 virus make continuing public health measures urgent

A news release: PAHO Director says new variants and acceleration of virus make continuing public health measures urgent. Excerpt:

Washington, D.C., January 13, 2021 (PAHO)— The appearance of new variants of the COVID-19 virus in several countries of the Americas, combined with an acceleration in the virus’s spread in virtually every country in the Americas, makes it critical to continue public health measures such as social distancing, wearing masks, and washing hands often, Pan American Health Organization Director Carisa F. Etienne said today.   

“Our collective ability to keep up with these measures has the power to determine the trajectory of this year. If we remain diligent, we have the power to control this virus; if we relax, make no mistake, 2021 could well be far worse than 2020," Etienne told a press briefing today.    

She said, “Since the start of this pandemic, over 39 million people across the Americas have become infected by COVID-19 and over 925,000 of them have succumbed to the virus. In the last week alone, 2.5 million people were infected with COVID-19 in our region – the highest weekly cases since the virus first reached our shores. “ 

PAHO's genomics surveillance network of 21 laboratories has been tracking the spread of the virus and mutations, she highlighted, and the variant first seen circulating in the United Kingdom has now been reported in eight countries: Brazil, Canada, Chile, Ecuador, Jamaica, Mexico, Peru, and the USA. In addition, Brazil and Canada have reported seeing another variant that was first reported in South Africa.  

“At this time, there is no evidence to suggest that these variants affect patients differently, but early data does suggest that the virus can spread more easily, accelerating the threat to our health systems at a time in which they are already close to capacity,” Etienne said.   

One vaccine has been approved by WHO to date and more are underway. Some countries in the region have started vaccinating health workers and vulnerable groups, but “as long as doses remain limited, we can’t rely on vaccinations to flatten the pandemic curve,” she said.   

PAHO’s priorities in 2021 include ensuring equitable access to protective equipment for health workers, medications and hospital care when required, and vaccines.    

“With the arrival of vaccines, we must ensure not just that doses are produced quickly, but that they’re equitably delivered and swiftly across every country – regardless of income. This will require global and regional collaboration and solidarity, with donors pitching in resources through mechanisms like the COVAX Facility,” the Director noted.

Los Angeles: Our century-old mask wars

Via The Los Angeles Times: Coronavirus Today: Our century-old mask wars. Excerpt:

Good evening. I’m Amina Khan, and it’s Tuesday, Dec. 29. Here’s what’s happening with the coronavirus in California and beyond. 

The pitched political battle over masks may feel like a quintessentially 2020 kind of conflict. But as it turns out, the anti-mask movement is more than a century old. Columnist Gustavo Arellano takes us back to 1919, when the world was facing another devastating global outbreak: the so-called Spanish flu, which is estimated to have infected a third of the world’s population and killed at least 50 million.  

Back then, more than 700 concerned citizens and doctors signed a petition asking the Los Angeles City Council to enact a mask mandate to combat the pandemic, or “the disease will come back again, and will exact a heavier toll than ever.” 

But councilmembers wouldn’t budge. One said the masks left the wearer “breathing in the foul air which they exhale.” Another snarked that he might have been more sympathetic “if the doctors would come through and agree on some one thing, or if any of them could agree at all.” A third said he would “not propose to take the advice of a lot of outsiders.”  

L.A. weathered the flu pandemic better than most major American cities, largely thanks to City Health Commissioner Dr. Luther Powers, who shut down businesses and schools early on, even when others did not. But Powers had a chance to save even more lives by implementing a mask ordinance — and he didn’t. 

If Powers had required everyone to wear masks in public, that “would’ve had an impact,” said J. Alexander Navarro, a medical historian at the University of Michigan.

Widespread mask use in L.A. seemed imminent when the Spanish flu hit California in the fall of 1918, Arellano writes. San Francisco issued an order for people to wear them outside their homes, and San Diego required them for anyone serving the public. Gov. William D. Stephens urged Californians to wear masks, saying they offered “but little discomfort and means a service rendered to our fellow-men and to our country.” 

These messages appear to have had an effect: The Times reported on Oct. 23 that masks in L.A. “were quite common in large offices ... where the general public is coming and going all day in numbers.” 

Mayor Frederick Woodman even brought a resolution to the City Council to enforce mask wearing, but Powers balked and the enforcement measure failed. Instead, the council passed a measure advising the public to wear masks, but not requiring it.  

The window of opportunity, it seemed, had closed. The council soon became hostile to a mask mandate. This paper openly called masks “muzzles” and published editorial cartoons mocking their advocates. In a Dec. 1, 1918, editorial titled “Adios ‘Flu’ Scare!” the paper’s editorial board wrote that “the real sufferers are the men and women whose incomes have been stopped, whose businesses have been all but ruined.” Sound familiar? 

Little did they know that the city was about to be overwhelmed by a second wave of influenza. In January, Powers finally wrote up a mask mandate but ultimately did not back its passage.

Did they have to die? How America's Covid-19 response left 3,000 health workers dead

Via The Guardian: Did they have to die? How America's Covid response left 3,000 health workers dead. Excerpt:

Workers at Garfield medical center in suburban Los Angeles were on edge as the pandemic ramped up in March and April. Staffers in a 30-patient unit were rationing a single tub of sanitizing wipes all day. A May memo from the chief executive said N95 masks could be cleaned up to 20 times before replacement. 

Patients showed up Covid-negative but some still developed symptoms a few days later. Contact tracing took the form of texts and whispers about exposures. 

By summer, frustration gave way to fear. At least 60 staff members at the 210-bed community hospital caught Covid-19, according to records obtained by KHN and interviews with eight staff members and others familiar with hospital operations.  

The first to die was Dawei Liang, 60, a quiet radiology technician who never said “no” when a colleague needed help. A cardiology technician became infected and changed his final wishes – agreeing to intubation – hoping for more years to dote on his grandchildren. 

Few felt safe.  

Ten months into the pandemic, it has become far clearer why tens of thousands of healthcare workers have been infected by the virus and why so many have died: dire PPE shortages. Limited Covid tests. Sparse tracking of viral spread. Layers of flawed policies handed down by healthcare executives and politicians, and lax enforcement by government regulators.  

All of those breakdowns, across cities and states, have contributed to the deaths of more than 2,900 healthcare workers, a nine-month investigation by over 70 reporters at KHN and the Guardian has found. This number is far higher than that reported by the US government, which does not have a comprehensive national count. 

The healthcare worker fatalities have skewed young, with the majority under age 60 in the cases for which there is age data. People of color were disproportionately affected, and account for about 65% of fatalities in cases in which there is race and ethnicity data. After conducting interviews with relatives and friends of about 300 victims, Guardian and KHN learned that one-third of the deaths involved concerns over inadequate PPE.  

Many of the deaths occurred in New York and New Jersey, and significant numbers also died in southern and western states as the pandemic wore on. 

Workers at well-funded academic medical centers – hubs of policymaking clout and prestigious research – were largely spared. Those who died tended to work in less prestigious community hospitals like Garfield, nursing homes and other health centers in roles where access to critical information was low and patient contact was high.

Garfield medical center and its parent company, AHMC Healthcare, did not respond to multiple calls or emails regarding workers’ concerns and circumstances leading to the worker deaths.

So as 2020 draws to a close, we ask: did so many of the nation’s healthcare workers have to die?

Christmas Covid-19 surge in Tennessee ‘will break our hospitals,’ says Health Commissioner Lisa Piercey

Via The Washington Post: Christmas covid surge in Tennessee ‘will break our hospitals,’ says Health Commissioner Lisa Piercey. Excerpt:

As Tennessee leads the United States in coronavirus cases per capita following a post-Thanksgiving spike, the state’s health commissioner warned Sunday that the hospital system will crumble if residents don’t slow the spread of the virus by staying home, wearing masks and avoiding large gatherings.  

“If we have another surge over Christmas, it will break our hospitals,” Tennessee Health Commissioner Lisa Piercey said at a news conference, according to the Tennessean.  

Despite Piercey’s warning, Tennessee Gov. Bill Lee (R) refused to order a statewide mask mandate in a video address hours later. Instead, he announced a new executive order to limit indoor gatherings to 10 people and implored people to keep holiday gatherings to just those in their household.  

“I understand deeply how much Tennessee families need each other,” Lee said. “But we must do all that we can to blunt this surge and keep more Tennesseans from getting sick.” 

The executive order comes one day after the governor’s office announced that Tennessee first lady Maria Lee tested positive for the coronavirus after exhibiting mild symptoms. In a statement, Lee said he tested negative and would quarantine as a precaution.  

Tennessee is averaging almost 10,000 new coronavirus cases, and almost 100 deaths, per day, according to The Washington Post’s tracker. About 2,800 people are hospitalized for covid in the state, with about 760 in the intensive care unit, according to the Tennessee health department. On Saturday, Tennessee recorded a 30 percent positivity rate, a new high, according to the Tennessean.  

In the weeks following Thanksgiving, daily reported cases in Tennessee doubled. A similar trajectory played out across the country, and health officials warn that Christmas gatherings could lead to an even larger surge.

Despite the rapidly increasing numbers pushing Tennessee hospitals to their limits, Lee maintained there would not be a mask mandate, while stressing the importance of wearing one.

“Many think a statewide mandate would improve mask-wearing, many think it would have the opposite effect,” Lee said Sunday. “This has been a heavily politicized issue. Please do not get caught up in that and don’t misunderstand my belief in local government on this issue. Masks work and I want every Tennessean to wear one.” 

Lee added that 70 percent of Tennesseans are already under mask requirements from their local governments and 80 percent said they wear their masks always or most of the time. 

“And I thank them for doing this,” Lee said.  

But medical workers criticized the governor for not going far enough to help them during a time in which they are drowning under the increasing hospital rates. Following Lee’s address, the Tennessee Medical Association, a nonprofit advocacy group for state physicians, released a statement imploring the governor to change his mind.

COVID-19 as the leading cause of death in the United States

Via JAMA Network: COVID-19 as the Leading Cause of Death in the United States. This is a grim but honest perspective, and condemns "the public and its leaders" for the disaster: 

The current exponential increase in coronavirus disease 2019 (COVID-19) is reaching a calamitous scale in the United States, potentially overwhelming the health care system and causing substantial loss of life. The news media dutifully report each day’s increase in new cases and deaths, but putting these numbers in perspective may be difficult. The daily US mortality rate for COVID-19 deaths is equivalent to the September 11, 2001, attacks, which claimed 2988 lives, occurring every 1.5 days, or 15 Airbus 320 jetliners, each carrying 150 passengers, crashing every day.  

A helpful approach to put the effects of the pandemic in context is to compare COVID-19–related mortality rates with the leading causes of death that, under ordinary circumstances, would pose the greatest threat to different age groups. The conditions listed in the Table include the 3 leading causes of death in each of the 10 age groups from infancy to old age. Using data from the Centers for Disease Control and Prevention, the Table shows mortality rates for these conditions during the period of March through October 20184 (the most recent year for which detailed cause-of-death data are available) with COVID-19 mortality rates during March through October 2020.  

Table.  Age-Specific Mortality Rates (per Million) for COVID-19 (March-October 2020) and Other Leading Causes of Death (March-October 2018)a

The Table shows that by October 2020 COVID-19 had become the third leading cause of death for persons aged 45 through 84 years and the second leading cause of death for those aged 85 years or older. Adults 45 years or older were more likely to die from COVID-19 during those months than from chronic lower respiratory disease, transport accidents (eg, motor vehicle fatalities), drug overdoses, suicide, or homicide. In contrast, for individuals younger than age 45 years, other causes of death, such as drug overdoses, suicide, transport accidents, cancer, and homicide exceeded those from COVID-19. 

Especially for older adults, the threat from COVID-19 may be even greater, for 3 reasons. First, the Table presents the aggregate 8-month mortality rate for COVID-19, not the current mortality rate, which has been increasing rapidly. Between November 1, 2020, and December 13, 2020, the 7-day moving average for daily COVID-19 deaths tripled, from 826 to 2430 deaths per day, and if this trend is unabated will soon surpass the daily rate observed at the height of the spring surge (2856 deaths per day on April 21, 2020). 

As occurred in the spring, COVID-19 has become the leading cause of death in the United States (daily mortality rates for heart disease and cancer, which for decades have been the 2 leading causes of death, are approximately 1700 and 1600 deaths per day, respectively). 

With COVID-19 mortality rates now exceeding these thresholds, this infectious disease has become deadlier than heart disease and cancer, and its lethality may increase further as transmission increases with holiday travel and gatherings and with the intensified indoor exposure that winter brings. 

Second, the reported number of COVID-19 deaths underestimates the excess deaths produced by the pandemic. Due to reporting delays and miscoding of COVID-19 deaths and an increase in non–COVID-19 deaths caused by disruptions produced by the pandemic, excess deaths are estimated to be 20% higher than publicly reported COVID-19 death counts. 

Third, COVID-19 is unlike other causes of death in the Table because it is communicable; individuals who die from homicide or cancer do not transmit the risk of morbidity or mortality to those nearby. Every COVID-19 death signals the possibility of more deaths among close contacts.  

The failure of the public and its leaders to take adequate steps to prevent viral transmission has made the nation more vulnerable, allowing COVID-19 to become the leading cause of death in the United States, particularly among those aged 35 years or older. Much of this escalation was preventable, as is true for many deaths to come. 

The prospect of a vaccine offers hope for 2021, but that solution will not come soon enough to avoid catastrophic increases in COVID-19–related hospitalizations and deaths. The need for the entire population to take the disease seriously—notably to wear masks and maintain social distance—could not be more urgent.